title: A stepwise aortic clamp procedure to treat porcelain aorta associated with aortic valve stenosis and hemodialysis.
abstract: A 62-year-old man was referred for an aortic-valve surgery because of severe aortic stenosis. Thirty years ago, he had undergone a mitral valve commissurotomy and after 9 years, the valve had been replaced by a mechanical valve. He had been undergoing hemodialysis for the past 8 years. A computed tomographic (CT) scan of the chest and abdomen showed a dense circumferential calcification in the wall of the entire thoracic and abdominal aorta, pulmonary artery, and left and right atrium. A conventional aortic-valve replacement was performed. To avoid an embolic event, a "stepwise aortic clamp" procedure was attempted and involved the following: (1) brief circulatory arrest and aortotomy during moderate hypothermia; (2) balloon occlusion at the ascending aorta during low-flow cardiopulmonary bypass (CPB); (3) endoarterectomy by using an ultrasonic surgical aspirator to enable aortic cross-clamping; and (4) a cross-clamp reinforced with felt and full-flow CPB. The patient recovered without any thromboembolic events. Using this procedure to treat a porcelain aorta seemed to reduce the time limit and reduced the risk of brain injury during cardiac surgery.
authors.affiliation: Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Isoda
authors.forename: Motohiko
authors.initials: M
authors.lastname: Osako
authors.forename: Tamizo
authors.initials: T
authors.lastname: Kimura
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishimura
authors.forename: Nozomu
authors.initials: N
authors.lastname: Yamanaka
authors.forename: Shingo
authors.initials: S
authors.lastname: Nakamura
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Maehara
mesh_terms: D001018:Aortic Diseases / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D002114:Calcinosis / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis